Transcription
Howard College Department of Dental HygieneApplication Packet20221 Page
It is the applicant’s responsibility to:1. Return the completed application by February 1, 2022 to:Howard College Dental Hygiene1001 Birdwell LaneBig Spring, TX 79720It is strongly encouraged that you mail the application with a return receipt requestedso that you know the application was received.The completed application packet may be returned to the Dental Hygiene Department Office atthe Big Spring campus, Horace Garrett Center, Room A19. Be sure that the packet is complete,or it will not be accepted.Please note: It is the applicant’s responsibility to keep his/her mailing address, telephonenumber, and e-mail current with the Howard College Admissions Office as well as the HowardCollege Dental Hygiene Program Office.Additional information on the web: http://www.howardcollege.eduClick the down arrow by “Programs”, scroll down to “Health Professions”, then click on “BigSpring Campus, then click on “Dental Hygiene.”PLEASE DO NOT FOLD THE APPLICATION PACKET2 Page
The DEADLINE for submitting a COMPLETE Dental Hygiene application packet is:No later than the close of business on February 1ST 2022.A complete Dental Hygiene application packet includes the following:1. Gain admission to Howard College and submit a copy of the acceptance letter in the application packet.All applicants must meet TSI (testing) requirements. Visit with an advisor to determine needs forassessment testing. Dental Hygiene requires the TSI status to be complete or exempt.2. After January 1 complete the following:a. Physical Examination of Applicantb. Dental Examination of Applicantc. TB Skin Test, TB Blood Test, or TB Chest X-ray3. Please return the following COMPLETED paperwork together in one envelope. DO NOT fold applicationpaperwork. Applications will be considered incomplete if all paperwork is not submitted together.a. Application for Admission to the Dental Hygiene Programb. Submission of all official, sealed transcripts from colleges/universities attended including HowardCollege. ALL COLLEGE TRANSCRIPTS HAVE TO BE MAILED TO YOU – KEEP ENVELOPES SEALEDAND INCLUDE THEM WITH THIS APPLICATION. Transcripts should include the fall semester’stranscript immediately prior to February 1st, if applicable.NOTE: Many colleges are now changing to online delivery of official transcripts. In the case ofonline delivery of official transcripts, please have your transcripts delivered to Leslie Owens(student registrar) and ask her to submit official transcripts to Belinda Lendermon, ProgramChair for Department of Dental Hygiene upon receipt of official transcript. It is the Applicantsresponsibility to make sure that Belinda Lendermon has the official transcripts necessary for yourcompleted application. In the event that the Applicant has failed to make sure that BelindaLendermon, Program Chair does not have all necessary transcripts, the applicant will bedisqualified.c. Dental Examinationd. Copy of Immunization Records showing all required programvaccinationse. Physical Examinationf. Dental Hygiene Observation Verificationg. Letter of Acceptance to Howard College.h. DANB certification copy, if applicable. Must be current.i. TSBDE registration copy, if applicable. Must be current.Applicants will ONLY complete a Criminal Background Check WHEN ASKED TO DO SO by the Dental HygieneDepartment. Once accepted to the Dental Hygiene program, you must have health insurance coverage ineffect no later than August 1. For those who do not have health insurance, go to www.ejsmith.com.3 Page
Application for Admission to the Dental Hygiene ProgramPlease PRINT or TYPEHC ID#Have you applied to the Dental Hygiene Program before?YesNoIf yes, what year?Date of dressStreetApt.CityStateZipCountyPhone/Contact InformationCell()Alternate()EmailSocial Security NumberDate of BirthMark the appropriate box after each question:Have you applied to the program previously?Are you a graduate of an ADA accredited DA/DLT program?Are you currently a DANB certified dental assistant?Are you a dental assistant registered with TSBDE?YESNOProvide the following information concerning your previous academic achievements.Identify all degrees you have achieved:No degree achievedAssociate DegreeBachelor’s DegreeMaster’s DegreeDoctorate DegreeOther4 Page
Application for Admission to the Dental Hygiene ProgramProvide the following information for every regionally accredited college, university, or vocational school youhave attended in the past OR are currently attending. You must provide this information, or your applicationwill be considered incomplete. Please include Howard College in the table below if you are currently or haveever attended.Name of college/universityCityDates attendedState Mo/YrtoMo/YrAreas of Study &# of credit hoursorDiploma orDegreeEarnedIf you have college level course work successfully completed outside of the United States, you must contactthe Admissions/Registrar’s Office (432) 264-5081 in order to have your course work considered fortransferability.Certain minimum physical abilities and characteristics are required in health sciences professions. Applicantsare required to complete a physical examination.I hereby certify the information contained in this application is true and complete to the best of my knowledge.I understand any misrepresentation or falsification of information is cause for denial of admission to the DentalHygiene Program or expulsion from the College after acceptance. I understand that information contained inthis application will be read by faculty, staff, and administrators in the dental hygiene program, as necessary.Signature of Applicant5 PageDate
Dental Examination of Applicant(SCHEDULE AFTER JANUARY 1, 2022)1. Name:Date of Exam:2. Address:3. City/State/Zip Code:4. Dental Health Overall:ExcellentGoodFairOther5. Date of last prophylaxis:6. Date of last radiographs: Type Taken:7. Remarks/Recommendations Regarding Dental Health:Printed Name of Examining DentistAddressSignature of Examining DentistCity/State/Zip CodeTelephone Number6 Page
Physical Examination of Applicant(SCHEDULE AFTER JANUARY 1, se: ernia: Feet:Varicose Veins:Posture:Spinal Curvature:Reflexes:Dizziness/Fainting: Lymph Nodes:Previous Surgery:Allergies (drugs/latex):TB Skin Test, TB Blood Test, or TB X-ray (Circle One)Date Taken:Date Read:Result:Vaccinations:1. Hep. B:Date: 1st 2nd 3rdDate of Titer: Results: NEGPOSIf negative, then get the 3-dose vaccination.Date: 1st 2nd 3rd2. VaricellaDate: 1st 2ndORDate of Titer: Results: NEGPOSIf Negative, then get the 2-dose vaccination.Date: 1st 2nd3. Measles/Mumps/Rubella Date4. T-dapDate5. InfluenzaDate (Optional)6. Meningitis DatePrinted Name of Examining PhysicianAddressSignature of Examining PhysicianCity, State, Zip CodeTelephone Number7 Page
Vaccinations Required for Admittance to the Dental Hygiene Program1. TB Test: Get a TB skin test, TB Blood Test, or TB Chest X-ray after January 1 of the year of application. If you areunable to get a TB skin test, then you must get a TB blood test or chest x-ray. The documentation must be included inthe application packet.2. Hepatitis B Shots: Most applicants are presenting with documentation showing they received the Hepatitis B3-shot series as a baby. If you received the Hepatitis B shots as a baby, then you must get a Hepatitis B Titer bloodtest. The Hepatitis B titer will show if you have an immunity to Hepatitis B. This is what we need to know. We do notneed to know if you have Hepatitis B. If the results of the titer come back positive, then you do not need to doanything further. If the results come back negative, then you must start the 3-shot series over. It will take 6 monthsto receive the series. You will receive the 1st shot the 1st month, the 2nd shot the 2nd month, and the 3rd shot the 6thmonth.When applying to the program, you must complete your 3-shot series before February 1st, or you could bedisqualified for not providing a complete file. There is also a 2-dose injection that is given 4-8 weeks apart foradolescents and adults who are 13 years in age or older.If you started the Hepatitis B 3-shot series after you were older, then you must get the Hepatitis B titer if it has beenover 10 years since you received the last shot in the Hepatitis B 3-shot series.There is another Hepatitis B blood test that tests for Hepatitis B surface Antigens (HBsAg) Antibodies. This test willtell you if you have Hepatitis B. DO NOT get this blood test. This is the wrong blood test. You need the Hepatitis BTiter blood test to show if you have an immunity to Hepatitis B.3. Varicella (Chicken Pox): The applicant will show documentation that he/she has received 2 doses of varicella(chickenpox) vaccine. If you have not had the varicella vaccine, then you must get a varicella titer (blood test). Ifthe results are positive, then you do nothing. If the results are negative, then you must get the 2 doses of varicella(chickenpox) vaccine and provide documentation in your application packet.8 Page
If you had chicken pox, then you need to get the varicella titer blood test. If the results are positive, then you donothing. If the results are negative, then you get the varicella 2 dose vaccination. The 2 doses are given 4 to 8 weeksapart for Adolescents and Adults 13 years old or older.4. Measles, Mumps, Rubella: Applicant must show documentation that he/she had the 2- shot series (the shots mustbe at least 28 days apart). If the applicant did not have the 2 shots as an infant, then an MMR titer (blood test) mustbe taken. If the results come back negative, then the applicant will have to get the 2-shot series again. Keep in mindthe series of shots must be completed before the application deadline and documentation must be included in theapplication packet.5. T-dap Shot: The applicant must have had a T-dap shot within the last 10 years of application to the Dental HygieneProgram. If the T-dap shot is over 10 years old, the applicant must get another shot and include documentation in theapplication packet.6. Influenza (Flu) Shot: This shot is optional, but you will be required to sign a waiver if you decide against the Fluinjection. You will also be required to wear a mask the entire day at your rotation to the Big Spring VA Medical Centerand any other rotation site, as necessary.7. Meningitis Shot: The applicant must have a meningitis shot if the applicant’s age is under 22 years.If you have any questions, contact the Dental Hygiene Department before going to your physician. The telephonenumber is 432-264-5065.9 Page
Howard College Dental Hygiene 1001 Birdwell Lane Big Spring, TX 79720 . Submission of all official, sealed transcripts from colleges/universities attended including Howard College. ALL COLLEGE TRANSCRIPTS HAVE TO BE MAILED TO YOU - KEEP ENVELOPES SEALED AND INCLUDE THEM WITH THIS APPLICATION. Transcripts should include the fall semester's
